1. IHCA Pre-Budget Health Sector Submission 2011 September 14 th, 2011 1

2. Health Sector Underfunding HSE budgets and NSPs underestimate demand for acute hospital and mental health services. HSE budgets and NSPs underestimate demand for acute hospital and mental health services. 2007 & 2008: €250 million annual deficits. 2007 & 2008: €250 million annual deficits. 2009 required supplementary increase (€260m) and additional service cuts (€280m). 2009 required supplementary increase (€260m) and additional service cuts (€280m). 2

3. 2010 Budget Underfunding HSE regional budgets collectively €140m (2.7%) over budget on July 31 st. HSE regional budgets collectively €140m (2.7%) over budget on July 31 st. Annualised shortfall of €241m. Annualised shortfall of €241m. Acute hospitals most underfunded at €110m in July (4.8%). Acute hospitals most underfunded at €110m in July (4.8%). Acute hospital shortfall of €189m on full year basis. Acute hospital shortfall of €189m on full year basis. 3

4. 2010 Budget Underfunding Primary and community care shortfall of €30m (July) or €52m in full year (-1.1%) Primary and community care shortfall of €30m (July) or €52m in full year (-1.1%) Mental Health 1.5% underfunded: €10m in full year. Mental Health 1.5% underfunded: €10m in full year. Combined acute hospital and mental health shortfall of €200m on a full year basis. Combined acute hospital and mental health shortfall of €200m on a full year basis. 4

5. 2010 Budget Underfunding RegionBudget Overspend Over Budget (Underfunding) West South €44.8m €17.3m 9.1% 3.7% Dublin North East€28.1m5.5% Dublin Mid Leinster€19.5m2.4% Total€110m4.8% July 2010 Acute Hospital Services Budget by Region Source: HSE July 2010 Performance Report 5

6. Insufficient Acute Hospital Beds O ECD confirms Ireland has 2.7 acute beds/’000 pop compared with OECD average of 3.8 acute beds/’000 pop. O ECD confirms Ireland has 2.7 acute beds/’000 pop compared with OECD average of 3.8 acute beds/’000 pop. HSE closing 17% of acute beds in 2009 (-900) and 2010 (-1,100). HSE closing 17% of acute beds in 2009 (-900) and 2010 (-1,100). Increasing demand for acute hospital services. (123,199 increase (+4.5%) treated by July 2010 compared with YTD Targets). Increasing demand for acute hospital services. (123,199 increase (+4.5%) treated by July 2010 compared with YTD Targets). 16% increase in waiting list numbers at 46,460 compared with the year earlier. 16% increase in waiting list numbers at 46,460 compared with the year earlier. INMO 12 month trolley count totals 70,116 up 11% on previous year. INMO 12 month trolley count totals 70,116 up 11% on previous year. 6

7. Budgets and HSE NSPs Underestimate Demand Source: IHCA based on HSE performance report data 7

8. Hospital Service Delivery Compared with NSP Targets Sources: IHCA based on HSE Performance Reports including the July 2010 Performance Report dated September 9 th. (* 2010 figures based on July 2010 outcome compared with YTD targets). 2007200820092010* In-Patient Discharges +2.5%+1.7%+3.5%+7.6% Day cases +2.5%+7.9%+4.3%+6.9% Emergency Presentations +5%+3.3%- 3.3% Emergency Admissions +3%-0.3%-0.4%+9.9% Outpatient Attendances +9%+18.0%+3.1%+2.6% Births (Year on Year) +10%+5.3%+1.1% -1% 8

9. Actual Acute Hospital Activity Source: IHCA based on HSE Performance Reports dated 11 th February 2010 and September 9 th, 2010. 9

10. Increases in Waiting Lists Source: HSE Performance Report 8th October 2009: August 2009 figures in brackets. HSE Performance Report 9 th September 2009: July 2010 figures not in brackets. 10

11. Source: ESRI Research Series 13, October 2009 Projected Increase in Outpatient Consultations by Hospital Network (2006 – 2021) 11

12. Mental Health Services Underfunding at €10m based on July performance report. Underfunding at €10m based on July performance report. Mental health funding estimated at 5.3% of HSE budget compared with Vision for Change recommendation of 8.4%. Mental health funding estimated at 5.3% of HSE budget compared with Vision for Change recommendation of 8.4%. Child and adolescent waiting list 2,779. Child and adolescent waiting list 2,779. Staff embargo disproportionally impacts on mental health services. Staff embargo disproportionally impacts on mental health services. Mental health capital budget 50% underspent. Mental health capital budget 50% underspent. 12

13. IHCA Budget Recommendations Funding for frontline acute hospital and mental health services should be increased in the 2011 budget because of: Funding for frontline acute hospital and mental health services should be increased in the 2011 budget because of: –Shortfall in funding based on July Performance Report. –Increasing demand: »About 2% per year »Need to half the waiting lists »Need to end the unacceptable use of trolleys/chairs instead of beds. »1.8% reduction in Private Health Cover –Unsustainable parts of 2010 budget. 13

14. IHCA Pre-Budget Health Sector Submission Thank you for your attention Q & A 14